AAFP President Presents Case to Senate Finance Committee

During testimony on Capitol Hill, AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., urged Congress to adopt a blended payment model that supports the patient-centered medical home (PCMH) as a way to improve health care quality and control costs.

AAFP President Glen Stream, M.D., M.B.I., makes a point about the importance of primary care and the patient-centered medical home for improving quality and controlling costs during a roundtable discussion on Medicare physician payment held by the Senate Finance Committee.

"The AAFP is convinced that no single alternative payment method will rebuild primary care," said Stream during a July 11 roundtable discussion(www.finance.senate.gov) on Medicare physician payment strategies that was convened by the Senate Finance Committee. "We need a combination of methods."

Stream stressed, however, that the PCMH is an effective means of improving quality and controlling costs. Findings from PCMH programs across the nation are demonstrating how the PCMH can achieve the simultaneous goals of higher quality and cost control, said Stream. He called on Congress to adopt a blended payment methodology that includes a fee-for-service component, a care management fee and quality improvement payment.

"We need to pay primary care differently and better" to create a more efficient, high-functioning health system, said Stream. As an example, he cited a bipartisan bill introduced by Reps. Allyson Schwartz, D-Pa., and Joe Heck, R-Nev., that "takes a notable step toward recognizing the critical need to pay primary care differently."

Stream participated in a five-member physician panel representing various factions of the medical community, including the AMA, surgery, cardiac surgery, and oncology. In his opening remarks, Stream said, "We all want the same thing; better health care at less cost." And that entails an investment in primary care, he added.

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During testimony before the Senate Finance Committee on July 11, AAFP President Glen Stream, M.D., M.B.I., said primary care and the patient-centered medical home (PCMH) are effective means of improving quality and controlling costs.

Panelists at the roundtable discussion included physicians from several specialties who agreed that a way has to be found to eliminate unnecessary costs in the U.S. health care system.

Senate Finance Committee Chair Max Baucus, D-Mont., called for repeal of the current Medicare payment formula and asked the panelists to submit ideas on what type of payment system should replace the current formula.

"We absolutely have to build a strong primary care foundation if we are going to have any success at improving the quality and cost effectiveness of our health care system," Stream noted.

The two-hour roundtable discussion gave Stream and the other panelists an opportunity to engage in a question-and-answer session with Senate Finance Committee members. Much of the discussion focused on ways of eliminating unnecessary costs in the health care system. For example, Stream called for "eliminating care that does not contribute to people's health."

"The patients' interest should be the highest priority -- making sure they get the treatment they need to improve their health," he said.

Sen. Orrin Hatch, R-Utah, focused on the lack of tort reform and the cost of defensive medicine. Defensive medicine costs billions a year, said Hatch.

Tom Carper, D-Del., asked whether it is possible to reduce the incidence of medical malpractice litigation and the incidence of defensive medicine. "Is it possible in doing both of those to get better health outcomes?" asked Carper.

Physicians should have the "ability to learn from mistakes rather than trying hide (mistakes) because of concerns about litigation," said Stream. We need to use mistakes as learning opportunities to continuously improve the quality of care, he added.

Sen. Maria Cantwell, D-Wash., asked the panelists if more can be done to encourage graduate medical students to pursue careers in primary care.

"There are strong disincentives for (students) to choose primary care," said Stream. "We have got to narrow the income gap between primary care and (sub)specialty incomes."

And Ardis Dee Hoven, M.D., president-elect of the AMA, said it was important to change the curriculum at certain medical schools to make sure primary care is being taught.

Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, got to the crux of the meeting when he asked the assembled physicians what could be done about the sustainable growth rate (SGR) formula, which has called for steep reductions in Medicare physician payment rates for the past several years.

"Every year, the flawed sustainable growth rate leads physicians to fear dramatic reductions in their Medicare payments," said Baucus. "Next year, physicians will face a 27 percent cut if we don't act. While Congress has intervened to prevent these cuts each year, it is time to develop a permanent solution."

He called for a repeal of the SGR and an end to the "annual doc fix ritual," and, as the hearing wrapped up, he asked each of the panelists to submit in writing their short-term, mid-term and long-term solutions for replacing the SGR formula.